Opening the door on hypersexuality

bp Magazine editors note: At every stage of preparing this important article, from interviewing sources to designing the layout, bp Magazine took the utmost care to address the topic candidly—to "open the door" on hypersexuality, as it were. At the same time, we steered away from unnecessarily graphic details, confident that we could tell the story without offending anyone's sensibilities. We hope you find our coverage balanced, tasteful, and helpful.

A few years ago, a middle-aged woman from Vancouver, British Columbia, happened to read an article about bipolar disorder and hypersexuality, written by her very own psychiatrist. In all the years she'd been going to see him, she was shocked to realize, this doctor had never once asked if hypersexuality was one of her symptoms.

"I wrote to him and said, 'This is me,'" the woman recalls. " 'You never told me about this part.'"

Hypersexuality may be the last frontier in bipolar disorder. Even now, despite everything that has been learned about the illness, it's hard to put a finger on how big a problem it really is. The research is limited. Only seven studies have ever been published on the subject and their findings diverge: According to these studies, hypersexuality occurs in 25 to 80 percent of all patients with mania. After reviewing the literature, Manic-Depressive Illness (the 2007 text by Frederick K. Goodwin, MD, and Kay Redfield Jamison, PhD) settled on an average of 57 percent.

And that hardly tells the story. For, despite its primal role in human behavior, sexuality remains one of the hardest, most sensitive subjects to dredge up in any but the most cursory details. Which explains why, while hypersexuality is listed as one of the primary symptoms of bipolar in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), many psychiatrists refer to it almost as an afterthought—if at all—when forming a diagnosis:

"Like, what do you mean?" demands Andy Behrman, who became a poster boy for bipolar disorder with the 2003 publication of his edgy, sexually frank, and popular book, Electroboy: A Memoir of Mania. "Am I having sex with strangers? Yes. Constantly masturbating? Yes. Can I get myself to a place where I'm fully satisfied sexually? No. As much as I want to shop, buy, and make money, that's as much as I want to have sex."

Though hypersexuality may present itself as just one aspect in a constellation of problems, it is often the most destructive and challenging part of bipolar disorder—troubling families of young children suffering from juvenile hypersexuality, ruining marriages, generating life-threatening health problems. "The one thing I regret is what I did to my husband," says Bev, a middle-aged woman from rural Quebec who was diagnosed with bipolar a few years ago. "He was a good man and we would have had a good retirement together."

Bev was diagnosed with bipolar in 2006, following years of unrelenting depression and anxiety. She had a strong family history of mental illness: Her mother died by suicide; her daughter is clinically depressed. But it wasn't until Bev reached her early 40s that her sexual impulses underwent a sudden change. She began "doing things I had never done before."

It began with extramarital affairs, mostly with younger men: "It was as if my husband couldn't see what was going on. He finally asked me and I said 'no.' The second time he asked me I couldn't lie," Bev recalls.

At least one study found that hypersexuality appears to play a larger role in women's lives than in men's. The 1980 study, led by Kay Redfield Jamison, PhD, a clinical psychologist generally regarded as one of the foremost experts on bipolar disorder—and one of its most well-known sufferers—reported that women with bipolar tend to be far more sexually provocative and seductive than their male counterparts. Further, Jamison found that twice as many women as men reported sexual intensity as "very much increased" during hypomania. The women in her study also rated sexual intensity as the most important and enjoyable part of mania.

Despite such findings, personal sexuality is a subject often avoided on the psychiatrist's couch. Indeed, patients complain that their doctors rarely want to hear about it. Whatever insights they've arrived at have come by way of friends and fellow patients, they say...

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